How Much Will Fully Insured Health Insurance Go Up in 2026?

What the data says and why your last renewal was not an anomaly

Your renewal came in higher than expected. You got a number, a percentage and a general statement that the market was up. What you did not get was an explanation of what produced it.

That gap is not unusual. The fully insured renewal process delivers a result. It rarely delivers the structural analysis behind it. And without that analysis, the number is just a number, something to negotiate around, absorb or pass along to employees, with no real visibility into whether any of those responses addresses the underlying problem.

HUB’s National Actuarial Team and four independent research firms surveyed different employer populations and reached the same conclusion: The increases fully insured employers are absorbing in 2026 are not a spike. They are the product of structural forces, specifically rising specialty pharmacy costs, behavioral health utilization and a deteriorating risk pool, that have been building for years and are not going to reverse on their own.

Five sources. One conclusion.

The Peterson-KFF figure is worth pausing on. Eleven percent is not the outlier. For employers in the small and mid-market, it is the median. If your renewal came in at 9% or 10%, you were at or below the midpoint for your peer group. If it came in higher, you are looking at something the data predicted.

This is the fourth consecutive year of elevated cost growth. The years when fully insured mid-market employers budgeted low- to mid-single-digit annual increases are over. The question worth asking now is not why the renewal was high. It is why the forces producing it are still in place for 2027.

Why this is structural, not cyclical

The factors driving 2026 rates operate well beyond any single employer’s plan. What your renewal reflects is a market-level cost structure, not your workforce’s claims experience alone.

GLP-1 drugs and specialty pharmacy

Pharmacy costs are projected to rise 10% to 12% in 2026, outpacing medical cost increases of 7% to 9%.¹ Nearly 30% of employers now report that GLP-1 medications represent 15% of their total claims, at roughly $1,500 per employee per month.^2,3Cancer treatment has been the top cost driver of pharmacy cost increases four consecutive years, with cell and gene therapies costing $500,000 to $4 million or more per patient.²

Behavioral health

Inpatient behavioral health claims are up nearly 80% since January 2023. Outpatient claims are up nearly 40% over the same period.³ The cost is not driven by what care costs per visit. It is driven by how many more people are seeking it. The fully insured premium reflects that demand at the pooled market level.

The deteriorating risk pool

Sixty-seven percent of covered workers nationally are now enrolled in self-funded plans. Among employers with 200 or more employees, that figure is 80%.⁶ The groups migrating to self-funded arrangements are predominantly healthier, lower-claims employers who can qualify for underwriting. The groups remaining in the fully insured pool are, on average, higher cost.

Carriers understand this dynamic precisely, and their 2026 pricing reflects it. The pool you are in is concentrating risk as the healthier groups exit and your premium now tracks the pool, not your own claims alone. As one senior HUB advisor put it: “There’s fee compression and real concern in this market right now because cost pressures are the worst they’ve been. The carriers know what their books look like and they’re pricing accordingly.”

Peterson-KFF found insurers explicitly citing “morbidity deterioration” in their 2026 rate filings. A Colorado insurer attributed a 4% rate adjustment specifically to the migration of lower-claims groups out of the fully insured pool.⁴

If your employees are healthy relative to the broader pool, your renewal increase is partially a subsidy to employers whose employees are not. That does not automatically point to self-funding; leaving the pool is one option among several, and the right structure depends on your group’s risk profile, not on a reflex to exit.

What 2027 is already shaping up to look like

Fully insured renewal pricing responds to what the carrier projects the pool will cost next year, informed by the multi-year trend, layered over historical claims and risk. Specialty pharmacy costs, behavioral health utilization and the migration of lower-claims employers out of the pool are all moving in one direction, and none of them is yours to fix. What is yours to decide is how your plan is funded against them.

Fully insured renewal pricing reflects two things at once: what happened in your plan last year and what the carrier projects the pool will cost next year. Your historical claims and risk set the baseline. Forward-looking projections layered on top set the direction. And that direction, as HUB advisors describe it consistently across mid-market accounts, is not a straight line but an upward curve compounding at 8%, 9% or 10% every year.

Average family premiums rose 6% in 2025 to $26,993, marking three consecutive years of 6% or more increases.⁶ The compounding effect accumulates fast. A fully insured employer who absorbed 8% in 2023, 9% in 2024, 8.5% in 2025 and 9% in 2026 is paying roughly 39% more per employee per month in 2026 than in 2022, before any change in headcount. A comparable employer that repositioned in 2022 is on a lower curve. Based on HUB’s five-year cost modeling, the cumulative difference between a fully insured trajectory and an alternative-funded peer over four years is approximately $2.5 million for a 300-employee group. That delta is the gap this analysis is about. The earlier an employer repositions, the lower the base that future increases compound against.

Some mid-market employers are already absorbing this differently. Not because the structural forces do not apply to them, but because they repositioned how their plan responds to those forces before compounding made the math harder to reverse. What they did first was not a leap to a new funding model; it was a structured read of how their premium was built, separating the dollars paying actual claims from the fixed administrative and risk charges layered around them.

The conditions that produced your 2026 renewal are still in place for 2027. The structural forces driving them are not negotiable. How your plan responds to them is. The analysis below shows what mid-market employers who are managing this differently are doing and what it would take to get there.

Download the one-page cost trajectory overview. No form, no follow-up required.

Read the full analysis: what your premium includes, what these structural forces mean for a fully insured plan at your size and what employers who have changed their trajectory did first.

Both are substantive.

HUB International’s National Employee Benefits Practice advises fully insured and self-funded employers across the United States on benefits strategy, funding structure and cost management. Results described in any case studies or client examples depend on group-specific claims experience, industry, geography and plan design.

¹ HUB International, “2026 Benefits Cost Trends Report,” August 12, 2025.
² Business Group on Health, “2026 Employer Health Care Strategy Survey,” August 19, 2025.
³ PwC Health Research Institute, “Medical cost trend is expected to hit 9%, highest in 17 years. Can cost management strategies bend the trend?,” June 11, 2026.
⁴ Peterson-KFF Health System Tracker, “How much and why premiums are going up for small businesses in 2026,” September 24, 2025.
⁵ Segal, “Some 2026 Projected Health Plan Cost Trends at 10‑Year Highs,” September 9, 2025.
⁶ KFF, “2025 Employer Health Benefits Survey,” October 22, 2025.